1. finance
2. bank
3. bank account

BLUE GUM PARK TENNIS CLUB INC ABN 93 745 715 829 Disney Street Brentwood WA 6153 Phone +61 8 9364 1638 www.bluegumparktennisclub.org MEMBERSHIP APPLICATION FORM
Acceptance of this membership application is subject to the applicant having an official International Tennis
Number (ITN), or playing to an acceptable level of play as judged by our Club Coach, Club Captain(s) or a
member of the Club’s Board of Management. For Junior applicants, an ITN is only required if you intend to play
league tennis. An ITN is NOT required if you only play junior social tennis.
Nominated by (please print)......................................................... Signature.....................................................
(Please ask a financial member of the Club to nominate you or contact one of our Board members / Club Captains / Club
Coach for further information on how to go about this)
Name of person making Provisional ITN assessment..........................................................……………………
(Club Coach / Club Captain(s) / a Board member)
Recommended Provisional ITN ….…...................…….
Title ……... Surname............................................................ Given Name ................................................……...
Occupation.............................................................................................. Date of Birth ...................................….
Address ..................................................................................………………………………..................….……….
..............………………………………………........................................................... Post Code..............................
Telephone No ..................................………........…..…..... Mobile…………..…........…………………..…...…...….
E-mail address ................................................................……….…...........……...................………….……..……..
Membership category (see over for details)..................................................
Student’s ID Number ………………………………................. Annual subscription payable $….......……….……
Parents’ names (juniors only) .............................................................................................................................
Please submit payment with this form (see over for methods of payment)
NB: if paying by internet transfer, please indicate date of transfer:.......................................................................
Current Tennis West ITN ranking (if applicable) .................................................. .................................................
Recent (previous 2 years) membership of other sports/business/social clubs or associations?
..................................................................…….............................................….………………...................………
How did you hear about Blue Gum Park Tennis Club? .......................................................…...................………
…………………………………………………………………………………………………...…………………………….
I hereby apply for Membership of the Blue Gum Park Tennis Club (Inc.) and agree to be bound by the Rules of the Club
(displayed inside the club house). I acknowledge that acceptance of this application is subject to approval by the Club’s
Board of Management.
Applicant’s Signature............................................................................ Date ...............................................……..
OFFICE USE ONLY
Date Received
MYOB entry
Tag Given
Y
Amount Received
Method of Payment
$
CASH
CHEQUE
EFTPOS
N
Please Circle
DIRECT DEPOSIT
Y
N
Welcome Info Sent
Y
N
CHEQUE NO………………………
Doc 01 – Membership Application – edited 29/4/2015
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BGPTC Annual Membership Fees for 2015/16
Category
Fee
Adults: 18 years and over as at 31 July
Full Adult
Young Adult:
Adult Student:
Week day
Country:
18 to 25 years inclusive, DOB required
full time University / TAFE - Student ID Number required
maximum of 12 playing days per year, must live
100km or more from Perth GPO
Social / non-playing
Social / Mid week
Parent
entitled to play with member children in daylight hours
$380.00
$240.00
$240.00
$285.00
$240.00
$60.00
$40.00
$100.00
Juniors
1st child
2nd child & others
Any child
(under 18 years at 31 July)
(under 18 years at 31 July)
(under 12 years at 31 July)
$135.00
$110.00
$95.00
Family Membership
Maximum fee for a family with full time student children
$900.00
Dual Membership
*Dual Membership - Winter
*Dual Membership – Summer
*Pennant Players Only – Conditions apply
$145.00
$195.00
Before submitting this application form, please ensure the following has been completed:
1. Personal details completed on this application form
2. A financial member of Blue Gum Park Tennis Club has nominated you on this form.
3. If you do NOT have an ITN, you have been assessed for a Provisional ITN. (This excludes junior applicants intending to
play junior social tennis only – no ITN required in this instance)
Submitting Your Membership Application
Please deliver your completed form to Blue Gum Park Squash Centre reception or send to:
Blue Gum Park Tennis Club
Disney Street
Brentwood WA 6153
OR
e-mail: admin@bluegumsquash.com
Payment Options:
1. cheque made payable to Blue Gum Park Tennis Club
2. cash or EFTPOS to Blue Gum Park Squash Club reception
3. internet transfer to Commonwealth Bank Account:
BSB:
066-163
Account number: 1033 5872
Account name:
Blue Gum Park Tennis Club
*Please include your name as reference and remember to write the date of your internet transfer on
your application form
If you would like further information regarding membership at our club, please contact:
Deb Innes
Club/Membership Secretary
Doc 01 – Membership Application – edited 29/4/2015
0409 546 002
e-mail: debinnesbgptc@gmail.com
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